| NPI | 1265790117 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OK 3204) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9106501) |
| 363AM0700X Physician Assistant, Medical (Licence: FL PA9106501) | |
| Enumeration Date | 2012-04-29 |
| Last Update Date | 2022-05-26 |